Risk factors for malaria and adverse birth outcomes in a prospective cohort
          of pregnant women resident in a high malaria transmission area of Papua New
          Guinea

Stanisic, Danielle I.; Moore, Kerryn A.; Baiwog, Francesca; Ura, Alice; Clapham, Caroline; King, Christopher L.; Siba, Peter; Beeson, James G.; Müeller, Ivo; Fowkes, Freya J. I.; Rogerson, Stephen J.

doi:10.1093/trstmh/trv019

Cited by 47 publications

(99 citation statements)

References 30 publications

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“…The six prospective cohort studies were all designed to assess risk factors and consequences of malaria infection and/or antimalarial treatment during pregnancy in different locations and among different study populations 1020 23 26 31 32…”

Section: Pooled Cohort Descriptionmentioning

confidence: 99%

“…24 The Asembo Bay ITN cohort (Kenya) identified pregnant women through monthly community census, and the FSP/MISAME (Burkina Faso) study recruited through a community-based network of home visitors 2125 Three studies excluded HIV-infected pregnant women,22 27 28 three studies did not assess HIV status21 30 31 and the remaining seven studies included both HIV-infected and HIV-negative pregnant women 1020 23 25 26 29 32…”

Section: Pooled Cohort Descriptionmentioning

confidence: 99%

“…The LAIS study, conducted in Malawi from 2003 to 2006, found that adding azithromycin to two courses of monthly SP (SPAZ) was better at reducing malaria at delivery, LBW and preterm birth than monthly SP or two doses of SP 2944 45 SPAZ was also superior when compared with the standard malaria prevention regimen used in PNG (SP plus chloroquine),30 where placental infection is an important risk factor for LBW 31. The EMEP cohort study found that use of artemisinin combination treatments during the first trimester was not associated with increased risk of miscarriage 23.…”

Section: Findings To Datementioning

confidence: 99%

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Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific

et al. 2016

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PurposeThe Maternal Malaria and Malnutrition (M3) initiative has pooled together 13 studies with the hope of improving understanding of malaria–nutrition interactions during pregnancy and to foster collaboration between nutritionists and malariologists.ParticipantsData were pooled on 14 635 singleton, live birth pregnancies from women who had participated in 1 of 13 pregnancy studies. The 13 studies cover 8 countries in Africa and Papua New Guinea in the Western Pacific conducted from 1996 to 2015.Findings to dateData are available at the time of antenatal enrolment of women into their respective parent study and at delivery. The data set comprises essential data such as malaria infection status, anthropometric assessments of maternal nutritional status, presence of anaemia and birth weight, as well as additional variables such gestational age at delivery for a subset of women. Participating studies are described in detail with regard to setting and primary outcome measures, and summarised data are available from each contributing cohort.Future plansThis pooled birth cohort is the largest pregnancy data set to date to permit a more definite evaluation of the impact of plausible interactions between poor nutritional status and malaria infection in pregnant women on fetal growth and gestational length. Given the current comparative lack of large pregnancy cohorts in malaria-endemic settings, compilation of suitable pregnancy cohorts is likely to provide adequate statistical power to assess malaria–nutrition interactions, and could point towards settings where such interactions are most relevant. The M3 cohort may thus help to identify pregnant women at high risk of adverse outcomes who may benefit from tailored intensive antenatal care including nutritional supplements and alternative or intensified malaria prevention regimens, and the settings in which these interventions would be most effective.

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Section: Pooled Cohort Descriptionmentioning

confidence: 99%

Section: Pooled Cohort Descriptionmentioning

confidence: 99%

Section: Findings To Datementioning

confidence: 99%

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Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific

et al. 2016

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“…In rural coastal Papua New Guinea (PNG), both P. falciparum and P. vivax infection are endemic [20], and malaria is an important risk factor for LBW [21], together with maternal betel (areca) nut consumption [22], macronutrient undernutrition [23], and tobacco smoking [24]. Here, macronutrient undernutrition and anaemia were observed to be key risk factors for measuring SGA and for poor fetal weight gain [25].…”

Section: Introductionmentioning

confidence: 99%

Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea

Ome-Kaius

Karl

Wangnapi

et al. 2017

Malar J

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BackgroundDoppler velocimetry studies of umbilical artery (UA) and middle cerebral artery (MCA) flow help to determine the presence and severity of fetal growth restriction. Increased UA resistance and reduced MCA pulsatility may indicate increased placental resistance and intrafetal blood flow redistribution. Malaria causes low birth weight and fetal growth restriction, but few studies have assessed its effects on uteroplacental and fetoplacental blood flow.MethodsColour-pulsed Doppler ultrasound was used to assess UA and MCA flow in 396 Papua New Guinean singleton fetuses. Abnormal flow was defined as an UA resistance index above the 90th centile, and/or a MCA pulsatility index and cerebroplacental ratio (ratio of MCA and UA pulsatility index) below the 10th centile of population-specific models fitted to the data. Associations between malaria (peripheral infection prior to and at ultrasound examination, and any gestational infection, i.e., ‘exposure’) and abnormal flow, and between abnormal flow and birth outcomes, were estimated.ResultsOf 78 malaria infection episodes detected before or at the ultrasound visit, 62 (79.5%) were Plasmodium falciparum (34 sub-microscopic infections), and 16 were Plasmodium vivax. Plasmodium falciparum infection before or at Doppler measurement was associated with increased UA resistance (adjusted odds ratio (aOR) 2.3 95% CI 1.0–5.2, P = 0.047). When assessed by ‘exposure’, P. falciparum infection was significantly associated with increased UA resistance (all infections: 2.4, 1.1–4.9, P = 0.024; sub-microscopic infections 2.6, 1.0–6.6, P = 0.051) and a reduced MCA pulsatility index (all infections: 2.6, 1.2–5.3, P = 0.012; sub-microscopic infections: 2.8, 1.1–7.5, P = 0.035). Sub-microscopic P. falciparum infections were additionally associated with a reduced cerebroplacental ratio (3.64, 1.22–10.88, P = 0.021). There were too few P. vivax infections to draw robust conclusions. An increased UA resistance index was associated with histological evidence of placental malaria (5.1, 2.3–10.9, P < 0.001; sensitivity 0.26, specificity 0.93). A low cerebroplacental Doppler ratio was associated with concurrently measuring small-for-gestational-age, and with low birth weight.Discussion/conclusionBoth microscopic and sub-microscopic P. falciparum infections impair fetoplacental and intrafetal flow, at least temporarily. Increased UA resistance has high specificity but low sensitivity for the detection of placental infection. These findings suggest that interventions to protect the fetus should clear and prevent both microscopic and sub-microscopic malarial infections. Trial Registration ClinicalTrials.gov NCT01136850. Registered 06 April 2010Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-1689-z) contains supplementary material, which is available to authorized users.

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“…PM can have negative health consequences for mother and child, including maternal anaemia, stillbirth, and LBW caused by preterm birth (PTB) and/or fetal growth restriction (FGR) [6]. PM-mediated morbidity and mortality is influenced by parity, maternal immune status, stage of pregnancy at infection, and chronicity of infection [7,8].…”

Section: Adverse Birth Outcomes In Placental Malariamentioning

confidence: 99%

Malaria in Pregnancy: An Unrecognized Risk Factor for Neuropsychiatric Disease in Offspring?

Tran¹,

Weckman²,

Kain

2016

Pediatric Infect Dis

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The in vitro environment has a profound effect on offspring neurodevelopment. Insults to the foetus during pregnancy can disrupt neurodevelopmental processes culminating in neurochemical and behavioural abnormalities. A growing body of evidence supports a role for maternal infection in precipitating neuropsychiatric disease in offspring. Sincẽ 60% of pregnancies globally are at risk of malaria infection annually, we hypothesize that in utero exposure to malaria in pregnancy (MIP) may be a neglected risk factor for mental illness. We propose that the host response to infection makes an important contribution to this risk. MIP may mediate neuropathology via immune activation and inflammation in the placenta and consequent dysregulation of processes critical to fetal neurodevelopment including cerebral angiogenesis, neurogenesis, synaptic pruning, and neurochemical regulation.

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Risk factors for malaria and adverse birth outcomes in a prospective cohort of pregnant women resident in a high malaria transmission area of Papua New Guinea

Abstract: In coastal Papua New Guinea, malaria and anaemia are important causes of adverse pregnancy outcomes.

Cited by 47 publications

References 30 publications

Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific

Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific

Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea

Malaria in Pregnancy: An Unrecognized Risk Factor for Neuropsychiatric Disease in Offspring?

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